Moments of honesty from a woman who has lost her way.

This American’s Experience of Britain’s Healthcare System

As the healthcare debate picks up pace, I find myself being asked with increasing regularity what I think of Britain’s healthcare system. Six months ago, I’d have jumped into the answer with gusto, but these days… I don’t know, I am just so fatigued by all the fear-mongering and hysteria, the ignorance and the downright idiocy of the current debate that I can hardly summon the energy to add my voice to the cacophony.

But the other night when a friend of my mother’s emailed me and asked that now-familiar question — what was my experience and what did I think of British health care? — and I was surprised to discover that, once the initial weariness had worn off, I found myself turning her question over and over in my mind, composing my answer. When I sat down last night and started my reply, the words fell out me, my fingers tapping rapidly at the keyboard and my mind so engrossed in the assignment that I was stunned when I finally looked at the clock: it was 2.30 in the morning. I had been so consumed because what I had to say had been bursting to come out, an outraged truth that was tired of being bottled-up and was begging to be told.

When I lived in the UK, I railed against the NHS (the National Health Service). I cursed every delay, every perceived inconvenience, every way it differed from the care I had received in the US. But I moved to the UK only a few months after graduating from university and, until then, I had been covered on my parents’ very generous insurance so I had experienced American healthcare only as a dependent. I was judging my British experience from a lofty and privileged position of someone who’d always had gold-plated insurance. And I was naive, because I’d never had to pay for it, never had to worry it wouldn’t be there, never really had to deal with the paperwork. I never really understood what I was comparing the NHS to at all.

I also realise with hindsight that a lot of what I held against the NHS had nothing to do with the system itself and actually were issues that could happen in any system. I blamed the whole system when the loo in my local doctor’s office or hospital wasn’t clean enough. I blamed the whole system when the only space I could find at the hospital carpark was miles away in the very furthest corner. I blamed the whole system when the doctors’ receptionist was grumpy or I didn’t much like my doctor’s manner (or his diagnosis). But the truth was that I believed in the healthcare system I had grown up in and I didn’t like the idea of socialised medicine — I didn’t like socialised anything — so I saw problems with it where-ever I chose to look. And I held onto that belief right up until I arrived back in the United States, and discovered that grumpy receptionists and dirty hospital bathrooms and annoying carparks can happen in any system — because they have nothing to do with the system itself. They’re management issues, human nature issues, and they happen everywhere. And a lot of the fear that Americans have about change in their healthcare actually center around these kind of issues that have nothing to do with the system itself, be it socialised or for-profit.

So my return to the US and my sudden immersion in the American healthcare system was a rude awakening for me and it made me look at both systems a little more realistically. There are great things about healthcare in the US — great things — and I truly do believe that the quality of the care here is second to none. But there are great things to be said about Britain’s system as well and the trouble is that, at present, far too few people are saying those great things and far too many here in the US are beginning to believe utterly ridiculous things about the NHS. Let me play a small part in putting that right by outlining my experience of the British healthcare system.

First, I’ll start by pointing out that the NHS is truly one of the most socialist — almost Soviet — healthcare models that a country could possible choose. Unlike the health systems in France, Germany, and most of the rest of the developed world, it is totally government-run, almost totally centrally-controlled, and supported entirely through taxation. It is mammoth — the single largest employer in Europe, which is incredible when you realise it serves a small country with only 60million people. And with that kind of size come huge problems — consultation times are too short and it takes too long to get test results, amongst other things. It is not a perfect system by any stretch of the imagination. But it’s important to realise that when I talk about my experience, I am talking about the kind of system that truly is the very far extreme of what the nay-sayers are claiming will be the end result of public health provision in the US. The British system is the very stuff of their nightmares and yet, the truth is, it’s nothinglike what they imagine.

My healthcare in the UK was never dictated by a bureaucrat. Decisions were made by me and my doctor alone, and whatever we decided was the right course of action was the course that was taken. The scope of care available to me was far, far wider than what is covered even by the ‘very good’ insurance policies I’ve had here in the US. There were no limits on the number of times I could see my doctor, or the number of tests/procedures/consultations/etc that I could have in a year (or month or lifetime…) Whatever was deemed medically necessary by my doctor was covered — period. In fact, I’ve experienced a lot more limitations on my care since I’ve moved back to the US — the most memorable of which was when I had to beg the insurance company to cover a single visit to a nutritionist when E2 was diagnosed with 12 food allergies and was severely underweight. That simply never would have happened in the UK — if she needed it (and she did), she’d have got it (as her sister did after being diagnosed with a single allergy). To illustrate the point further, when I gave birth to E1, I stayed in hospital for five days because she had problems with breastfeeding — and that was entirely mydecision. I was free to leave hospital whenever I wanted, be that after one day or after a week, and I had the full support of the midwives to stay until they were sure we were breastfeeding properly and ready to leave — no administrator/bureaucrat/insurance company made that decision for me!

There are delays — there are delays — but to be honest I have experienced delays just as bad here in the US. In the UK, I might have to wait weeks or months to see a specialist if my case was not urgent, and that was frustrating. Here in the US, when I was in excruciating pain last year (so bad that I lost control of my bodily functions when the pain hit), I was referred to a breast surgeon by the ER doctor (7 hour wait in ER) — but the trouble is that we had to call five medical centers before we could find a surgeon who could see me any sooner six weeks, and even then it was only because they had a surprise cancellation. And the last time I needed to take E2 to the allergist here in the US, the earliest they could fit me in was two months later. There are delays in both systems. And by contrast, you can get very speedy service in the US… and you can get it in the UK too. When I needed to see my GP in the UK, I rarely had to wait until even the next day. When I thought I’d found a lump in my breast, I saw the doctor the next day and was sent to a specialist within the week.

I had my choice of doctors. My small rural town had two GP offices (a GP is a General Practitioner, a family doctor) with about 5 GPs in each office — I could choose either office and any GP in that office I chose. I could choose to go to the GPs office in a neighbouring town if I prefered (though some offices limit the regional area they’ll cover). I could change GPs at anytime for any reason, no questions asked. When I had my babies, I had my choice of any of the hospitals in the region, or a homebirth (the midwives in my area loved doing homebirths!). When my GP referred me to a specialist, he’d send me to whomever he thought best, but if I wanted someone or somewhere else, I could request that, no problem. And I always had the option of a second opinion, either through another NHS doctor or a private doctor.

I never once received a bill in the UK. There are no copays, there are no deductibles, there is no such thing as max-out-of-pocket. I have an NHS card which I showed at my GP’s office when I registered, and from that point on, I never had to fill out any forms or show any ID ever again. In fact, I think I lost my NHS card years ago — I have no idea where it is. It doesn’t matter — I don’t need because I am covered for everything once I am registered with my GP. When I stepped on a piece of glass and sliced up my foot, I went up to the local hospital, was seen immediately (rural hospital on a Tuesday afternoon), they took note of my name and address, patched me up, and I went home — simple as that. No bills, no paperwork, no hassle. Yes, Brits pay to cover it in their taxes, but the cost spread across the entire country and so it isn’t nearly the burden that insurance is for Americans. In fact, Brits spend only 8.4% of GDP on healthcare, compared to the 16% of GDP spent by Americans and what they get back is a system beats the US on so many basic measures of healthcare results. This is good quality care.

Brits believe that healthcare is a human right and are happy to have a system that covers everyone, all the time. They are HORRIFIED when they hear stories of Americans who have to hold fundraisers to pay for desperately-needed operations. It blows their minds that anyone goes bankrupt or loses their home because of medical bills. The idea that someone would lose their coverage because of a pre-existing condition or because they are so sick they can’t work is totally alien to them. These things simply do not happen in Britain.

Even with a comprehensive healthcare system that is available to all and completely free (at the point of delivery) the UK still has a healthy private system running alongside the state system. There are numerous large private insurance companies providing private health insurance to those who’d like to have it (or whose companies want to offer it). There are private hospitals up and down the country. Most specialists practice both within the NHS and also privately (they split their weeks). You can pretty much get your healthcare however you’d like — on the NHS, through private insurance, or paid out of your own pocket. I hear people in the US saying that with in the British system, you can’t see anyone but your government-assigned doctor, but that is totally untrue. And you can chop and change your care as it fits your life — I’ve had my care for an medical issue start on the NHS, and then switched my care to my private insurance if it suited my needs better. I’ve had other medical issues that I stayed with the NHS for the whole way. And when my husband had an elective medical procedure done that was covered by neither the NHS nor insurance, we simply paid for it out of pocket. It’s a flexible system and the private sector has not been quashed by the fact that there is a comprehensive, free public system running alongside it.

Because healthcare is not tied to employment, companies are free to focus on their core business and people are free to make career decisions (and life decisions) based on what is best for them instead of what preserves their healthcare. Brits never worry about keeping their healthcover — they never worry about pre-existing conditions; they never worry about continuity of care if they change jobs; they never get trapped into a bad-fit job because they have to keep their healthcover. They are much freer to be entreprenuers than Americans, because their only worry is whether their business will succeed, not how they’re going to provide healthcover for their families when they’re self-employed. Companies, particularly small companies, are free to focus on their core-business because they not burdened by the administration of healthcare for their employees — they never have to pay someone in HR to manage health benefits; they don’t have to juggle insurance companies and negotiate lower premiums; they don’t lose employees because their healthplan isn’t as good as some other company; they don’t see their bottom line rocked by a sudden rise in premiums. Decoupling healthcare from employment is hugely freeing to both individuals and employers, and can actually a very good thing for the economy at large.

When things go wrong, the government answers to the people in a way that insurance companies never do. For example, there was a cancer drug called Herceptin which was not covered on the NHS because of the cost. A group (led by Ann Marie Rogers) began a campaign to change this, suing their local health trust, and gained huge public support. They ultimately won their case and got their local trust to offer the drug — but because of the political pressure this campaign had created, the government extended the drug to the entire country. Imagine trying to convince an American insurance company to cover some expensive drug that they don’t want to cover, and then having that decision convince every other insurance company to do the same. And again, when I moved to the UK fifteen years ago, wait times in the NHS were much worse than they are now — but the public got fed up with it, made their voices heard in the General Election, and the new administration made cleaning up the NHS one of their highest priorities.

There is an emphasis on preventative care and the simplest way this happens is that people actually go to see their doctor when they are sick. Because there’s no cap on visits and no copay and everyone is covered, hardly anyone hesitates to go to the doctor when they need to, which gives them a chance to catch little issues before they become big issues and spot contagious diseases before they spread to the rest of the population. And here’s another way the focus is on prevention: when I had my babies, the midwives came to my house to check on us every day for the first 10 days after the baby was born, and then the Health Visitor (a community nurse) came to the house once a week for six weeks, and then I could go to her clinic (held once a week in town) for as long as I wanted after that with any concerns I might have (as well as being able to see a doctor — my choice). It’s all done to ensure the mother and baby are healthy and well, to support breastfeeding, and to catch problems as early as possible. I was utterly shocked when I found out that most new mums in the US are simply sent home with their babies, with no follow up in the first six weeks, and left to muddle through as best they can!

None of this actually tells you anything. Isolated anecdotal stories (like these) don’t actually give anyone the information they need to decide the merits of one system over another. All it does is tell you whether my particular doctor was good or bad, whether the nurse I encountered was having a good day or a bad day, whether the receptionist liked her job or hated it. There are good stories and bad in both systems, and it just depends on who you talk to. It’s much like public schools. You could ask parents across the US to tell you what they think of their kid’s school and you’d get a whole spectrum of answers: some schools are good, some are bad, some districts are rich, some are poor, some teachers are passionate, some have lost the will to live. But none of these things tells you whether the overall concept of publicly-funded schools is a good or bad one. If you drew your conclusions based on a bunch of stories from a handful of people about their personal experiences, you’d only be getting part of the story. And it’s no different with the concept of public healthcare.

I can sum up my experience of the British and American healthcare systems in one simple sentence: given a choice between the two systems, I’d choose the NHS in a heartbeat. And though this is the experience of only one single person out of millions, unlike so much of the propaganda and hysteria surrounding the current healthcare debate, it is the absolute Gospel truth.

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Addendum: This is an incredibly important issue with a lot of misinformation flying about. If you have experience of both the US and UK healthcare systems, I invite you to please leave a comment here and let us all know what you think of both systems. This debate needs more voices of experience and a lot less uninformed fear.

419 Responses

This is a VERY well written a fair post. Of course, my opinion of the NHS is equally subjective and I’ve witnessed some horrific things – but, like you, I’ve softened slightly after living in America simply because of the COST of this amazing health care.

This debate is interesting; especially the misinformed neurosis of right wing propoganda in the USA. This posting is excellent although rightly tempered by it’s admission of anecdote.

Overall the average person is going to be better off in the NHS. The NHS is undergoing huge change with more emphesis on choice, prompt access and reduced waiting times for treatment, following years of increased investment. The propoganda is out of date and ridiculous (especially for waiting times).

I’m a GP working in the UK. I’ve lived in the USA in my adult life and also worked in New Zealand as a Doctor. The NHS is not without problems, but no system is, but on balance I believe it is the best in the world.

For my 13000 registered patients (with my fellow 9 primary care doctors) we offer appointments based on medical need on the same day and in a week or so for routine problems. We do some evening and weekend surgeries. If patients need a home visit they will have one on the day. We have nurse practioners who triage same day emergency problems. Patients can attend as many times as they like / need. We can do as many tests that are needed in the surgey including ecg, blood tests; or at a hospital 4 miles away including same day ultrasound, xr, and CTs. MRIs can also be arranged. Patients with sinister symptoms not needing immediate admission will be seen within 2 weeks of referral, often sooner. Most routine conditions from referral to operation will be completed within 4 months, often less. We have in-house counselling, physiotherapy, midwife, health visitors, district nurses and social worker. Referrals are done on line and I can book appointments for patients from a choice of hosptials and specialists. Patient records are fully computerised and investigation results are returned electronically. We call patients on the telephone for quereies. We process 100s of presciptions a day. We do minor surgery, cryotherapy, travel vaccinations, student teaching, training doctors, we routinely visit nursing homes and look after these vunerable people as we would the younger.

For chronic disease we have 1000s of patients that see specialist nurses in the practice for diabetes, COPD, asthma, heart disease, kidney disease etc. We can commence insulin in house, perform spirometry etc; as many times as the patients need.

We manage our patients based on clinical need and evidence-based medicine.

This is all free at the point of need (or via taxes less then 10% national income). Only about 10% prescriptions have a cost paid for by the patient (£7, c.$10); the rest are free.

About 10% of patients need a referral for specialist care.

Contary to the government-controlled nature of the NHS as feared in the USA, I’m an independent, self-employed contractor in the NHS. The partners own (via mortgage) our well cared for grade 2 listed building and receive income based on our list size, the breadth and depth of services we offer and the quality of care. We run our own management structure and employ 40 staff and are responsible for their tax / pension etc; the tax payer isn’t.

In the UK GP services account for 90% of patient contacts (350 million per year) in the NHS with only 10% of the budget, This equates to about 1.8 billion patient contacts in the USA per year.

Patients can have private health care too, and now it is unlikely to not affect your NHS care.

Recent problems are 1. the media-obsessed myth over over-paid GPs (in fact since the new contract for GPs the perceived increase of income has disappeared via the different way we now pay for pensions and national insurance, and 4 years of pay freezes until this year’s 0.7% increase), fortunately GPs are the most trusted group of individuals in the UK; 2. unnecceary government dictats; 3 the hospital system – often dirty, inefficient, low levels of nursing prioritising paperwork over patient care mainly because of poor management; 4. mental health services.

However, most of it is getting better, with many brand new hospitals – and at least the current financial climate should improve efficiencies.

How are the GP’s designated? Are they selected by the patient; assigned by where you live; are there waiting periods to be assigned, etc? I am curious to know if it works like the HMO type of assignments.

Gabe,
I can’t reply with the authority or accuracy that Dr. Cox can but, as he left his comment over a year ago and I suspect he may not be back for a long while to see your comments, I’ll respond to your questions. The answer is that, in Britain, you are not “assigned” a doctor — you choose one and register with him/her, the same as you do in the States. Actually, it’s much easier than it is in the States, because you don’t have to check to see if the doctor is covered by your healthplan — almost everyone in the UK is covered by the NHS, and almost all GPs are NHS doctors, so you have your choice of literally any GP. Now, just as in the US, some doctors may not be accepting new patients, and some practices limit their patients by geographical location (to ensure they are serving the residents of their own community) but, beyond that, you simply choose the doctor you want.

When I moved in the UK, I’d ask my neighbours which doctors they recommended. My one neighbour went to Dr. Smith at Practice A, and my other neighbour had tried Dr. Jones at Practice B, but hadn’t liked him, so had switched to Dr. Miller. I actually went to one doctor for years and liked him very much but once, when he was on vacation, went to another doctor in the same practice and realised I liked him much better, so from then on, I always made appointments with the second doctor, even though I was still register with the first doctor. No problem. And one of my dear friends in the same town actually preferred the doctors at a practice in the next town, so she went there instead.

The reason for geographical limitation is so they can visit you at home if you require it. Kinda makes sense that you live near your gp then?!? When I became a student I had to register in two places, but it’s not absolutely necessary.

Even if you are initially assigned a GP – I’ve had one so long I don’t recall – you can change that GP any time you like. In a group medical practice you can request to see any doctor there, and if you don’t like any of them you can change to another practice. No questions asked.

If you want to see just one person’s experience of the NHS, try reading my blog with the experiences over the birth of my son who is now 12 weeks old. Born in Canada and living in England for nine years, the NHS may have its faults but it has saved my son’s life – with no expense spared. http://www.walkingforadam.blogspot.com

So your son almost died because you were not tested for GBS, a test that is covered by insurance and practically mandatory at just about every practice in the US, but must be payed for privately in the UK? A simple swab and a round of penicillin could have saved him a lifetime of doctors care. Why is this test not a routine part of the NHS coverage? Apparently not EVERYTHING is covered by the NHS.

Thank you so much for detailing your experience of the NHS, I’ve been absolutely disgusted over the past few days at the insinuations of American right-wing politicians that the NHS allows people to die, mistreats people etc. Even one of our own politicians has joined in!

If Fox News and their cronies wanted to tell people the true story they’d consult those who use the NHS, that is to say most people living in the UK and I know they wouldn’t be happy with the response. What you have posted here is the absolute truth, there is nothing to be gained from misleading people about the NHS and I’m glad your experience is up here, ready for someone who might be interested in the truth to stumble across it.

The American right have offended a lot of people in the UK with their outright lies recently and the response online is proof that we’re not going to sit and take it – we’re not going to be used in this way for these scumbags to harm their own countrymen.

Not everyone who is unsupportive of socialized/universal/public/tit-tacular/wtfever you call it health care is a Republican, a right-winger, a Nazi, or a puppy rapist. Oy.

Well written post, but as you note, Strawberry, it doesn’t really mean jack. I’ve had horrendous experiences with US health care and I’ve also had awesome ones. This has happened while insured and uninsured. Frankly, the fact that no one seems able to talk about health care rationally is a problem and won’t exactly make me see the pro-socialized health care side’s point of view. The responses I’ve gotten usually boil down to “OMG Y DO U H8 POOR PPL?!?!?!?”

Why is it that, when Bush & Co. did this from 2001 – 2009, it was a travesty, but if Obama’s administration & supporters shut down a dialogue about the matter, it’s okay because the dissenters must omg! hate poor ppl! I’m not even talking about the Townhall idiots who are screeching their points, rather, I’m referring to normal people – like myself – who simply disagree or need some clarifications.

I don’t think you are correct to say that this post bears no weight. Although there are personal anecdotes in it, there is also a broader analysis of the overall costs and benefits of each system. The UK has a higher level of public health and longer lifespan than the US and a system that costs about half as much. That is not anecdote.

I appreciate this post for having been so honest about failures as well as successes and for being so reflective concerning her own biases.

I would like to thank this blogger for a sane contribution to a debate that is dominated by insanity.

You are a right wing nutjob and may I offer some advice? Perhaps you should keep off the booze when you are making your screen name. In the NHS, they do offer alcohol rehabilitation programs to help you with your alcohol problem.

You certainly are not part of what we call “normal people.” Normal people would like a system like NHS, because of the insanity of the out of control spiraling costs of health care in this country. You are so simplistic and naive in your thinking if you believe that most people’s argument reduce to “OMG Y DO U H8 POOR PPL?!?!?!?” Wow. What bad form. You are making people who prefer healthcare reform seem uneducated and dramatic. You certainly don’t seem any better or offer any solutions.

Bush & Co. was a travesty. A travesty for America and the rest of the free world. Put two unfunded wars on the American credit card, destroyed Iraq, and destroyed the American economy. With Obama, at least he is trying to undo the mess Bush did in his 8 year reign of terror over this country.

Bravo! It’s nice to hear some truth in this debate instead of nonsense about death panels, euthanasia, eugenics, bureaucrats on every corner and the rest. How was your dental care whilst you were in Britain? I hear a right-wing Fox “news” person broadcast a scare story about a Brit who fixed his tooth with superglue because he couldn’t get NHS care. I don’t think the TV guy told the audience that dental care was partly privatised by the last conservative government (well, he wouldn’t want them getting the right end of the stick would he?). NHS dental care is not always available these days so If you don’t have it you have to get insurance or superglue. If there were still universal dental coverage on the NHS there would be no need for the superglue, yet private dental care would still not be banned by diktat!

British Dental Journal in 2001:http://www.nature.com/bdj/journal/v190/n3/full/4800900a.html
Approximately 50% of GDPs nationally concentrate on NHS dentistry (85% or more of their patients are treated under the NHS); 25% treat more than 70% of their patients privately; the remaining minority of practitioners fall between these two positions treating moderate proportions of both private and NHS patients

I wish I had wrote this myself. The other big argument I have for the NHS is that there is so much less of a lawsuit culture as people aren’t afraid of the cost of their care. Also, the NHS can negociate for prescriptions at a cheaper rate because so many people will receive them.

I love being able to go to my GP so easily without paperwork and the bureaucracy. Love it.

I have been avoiding the whole conflict because most people make their decisions based on ignorance and the ‘horror stories’ they hear and it is just so frustrating to me. Both sides have horror stories but I think it is truely horrific when someone does not go to the doctor because they do not have insurance and once they have insurance they are diagnosed with advanced stages of cancer and only 2 weeks to live.

And your point about spreading the cost of healthcare across the whole country was exactly my point as well. Whether I make $100 a month or $100,000 I still have to make the same insurance premiums.

Thank you so much for this wonderful, informed, very well-written post amidst all the madness surrounding this topic. I am an American who has lived in Britain for the last 20 years. Like yourself, my only knowledge of the US health system was under the umbrella of my parent’s coverage. Long, long waits in the ER when as an active little one I had various breaks and sprains, but was patched up and fixed up just fine. Paid for what I had to pay for as it was not free there (yes, birth control). Didn’t have healthcare between leaving university and working my first job but shortly after that moved here to study. I have found the NHS to be wonderful in caring for my father-in-law, mother-in-law and other of husband’s relatives as necessary.

And myself, when I most needed it. I contracted (came down with? caught? I still don’t quite understand) a very rare thing called Gullain Barre Syndrome. Can be life-threatening, but not when you ring NHS Direct for advice (so brilliant), go to a very well run NHS Walk-In Centre (was between Doctors at the time, had just moved boroughs), are diagnosed by a brilliant nurse, sent straight to A&E – not my local hospital, but the right one some distance away, who could deal with the problem. Was in hospital for two months from start to finish – ward, HDU, Intensive Care (10 days) back to HDU, back to ward, finally in physical rehabilitation. Faultless, brilliant, caring care from start to finish. I was paralysed for two weeks (that’s what GBS does to you). Fed, washed, cared for by brilliant nurses, the top neurologist in Europe (one of the top in the world), one of the best specialists on GBS that there is in the world, all these people contributed to my care.

I’d pick the NHS in a heartbeat and I’ve got great cover. The neocons talk about ‘rationing’ – which I think was done when I needed a specialist X-ray that didn’t exist within my county and I had to fight the insurance company to cover one in another county, or when I had to call around to umpteen specialists to get one that would ‘take’ my insurance.

PS- As I said above, not everyone against socialized health care is a right-wing, Republican, Nazi-tastic, puppy raping fascist. Many of the people against it are normal people with concerns and questions that are being swept under the rug Democrats under the guise that they’re being “un-American.”

Woah, is it 2006 again? I thought the HOPE!CHANGE! Administration was supposed to change all of that?

The reason the USA has not had an NHS is beacuse the right wing media which is owned by the corporate sector and the insurance companies poison peoples minds against it. Take no notice of Daniel Hannan MEP he is a lying cheating anti-christ.
The NHS is a wonderful system and it provides universal healthcare for all. Private health care systems don’t really work, because if your plan does not cover your illness then you have to pay. Private health care also punishes the wealthy and middle class. If you have worked hard and made your self rich, then why should you lose everything you have worked for because you have come ill.
Any way in the States, The military and police and Veterans have a universal plan, so why can’t every one else?

Thank you Strawberry for putting time and effort into writing this. I am guiding my friends to your post and emailing a few people while giving you full credit for this very informative post.

What amazes me is the very people who would benefit from a service like NHS…are the most against it. Such a fear of socialised medicine yet they have roads, schools, libraries, public services, military to defend our freedom all paid for by our taxes.

I’m another American Expat who would prefer something like the NHS to what the US Health Care system is like right now.

Having had both health care systems myself I would pick the NHS. Its not perfect. The US system if far from perfect as well. My mother has had horrible care in the US. Kaiser over medicated her. She nearly died. I have gone into the hosptial and argued with her doctor who said she was just feeling the pain of becoming elderly when she had a broken rib. The care given in the US and the UK are comparable. You good and bad doctors in both. Caring and uncaring nurses in both. Clean and dirty hosptials in both.

The fact that no one goes without medical is the bottom line. No one should have to pick between eating or medicine. No one should have to pay $100s just to get the medicine they need. No family should lose their home because a family member becomes ill. Its wrong.

People who say that because they have insurance so who cares if anyone else does is just selfish. One day they too may have to be frightened because their child is ill and they cant afford to see a doctor.

I hope that the US wakes up to the reality of the situation. I hope my sister who has no insurance because she was laid off and cant afford COBRA will get coverage. I hope no one ever has to go through what you have had to go through to get medical coverage for their kids.

I am an American living in the UK. When I first moved here, I had incredibly horrible preconceptions about what the NHS would be like and really dreaded having to engage with the healthcare system here. My first few experiences were a bit underwhelming from a customer service perspective, but that had very little to do with the NHS and far more to do with me expecting American cheerfulness and ‘bend over backwards’ customer service in British culture – which just doesn’t exist here, not even in restaurants. Now that I’ve had nearly 2 years of experience with the NHS as well as one of the UK private insurance providers, I can categorically say that I prefer the system here to what I had in the US. My husband and I will NEVER have to have the same conversations which I know my friends and family back home have about ‘how are we going to pay for our kids insurance if you change jobs?’ and ‘we just can’t afford the copay on that procedure this year so you’ll have to wait’. We will never have to worry about not being able to afford a prescription, or choose taking my prescription over buying groceries – positions that some people I’m close to in the US have been put through. And we would never, ever be put in a position where we couldn’t have a child because we couldn’t afford the prenatal care or delivery deductibles. None of those pressures exist in the UK’s socialised medicine system and I don’t resent the taxes I pay to support it – not by a long shot!

I totally agree with you! I am an American living in England (moved here last year with my husband, who is British). Within 2 days of arriving in the country, I had my first appt, my diabetes medications sorted, and no worries at all! I can usually get an appt at our local surgery the same week – unheard of where I moved from in the States.

For the people that think its ‘free’, we DO pay for the NHS. It comes out of our paychecks. In the US, you pay out the nose for medical insurance. As a single, I was paying about $100 a month. If I wanted to add my son, it would have almost doubled, and at the time, I couldn’t afford that. Heaven forbid you had to have a ‘family plan’. I’d seen some that were upwards of $800 a month!

The only complaint I have, and its not really a complaint but more of a “I wish this were different”, is that mammograms are not ordered until a woman is 50, and cervical screening is not ordered until a woman is 25. 2 of the most common diseases in women that are more likely to be treatable if caught early enough. However, that being said, you WILL get an appt for a screening immediately if you go to your GP and tell them you found a lump.

Though I am planning on staying permanently in the UK, if it happens that we do move back to the US, I dread the thought of going back and dealing with the red tape, bureaucratic BS, co-pays etc.

If you get to 50 please press for a mammogram or earlier if it is worrying you or if you ‘find a lump’. My mum was screened at 53 as it works in a 3 year cycle. They found a lump and gave her excellent care but she died of cancer at 61. I am told I should go for a mammogram 5 years before she was diagnosed but the age still stands at 50. I think I shall be either finding a lump at 48 so I can be screened or having a private mammogram.

A great article which covers the issue accurately and concisely. I am dual citizen, living in the USA right now and am horrified at the stories which are being circulated by the Republican party to protect their corner, risking the health and livelihood of the majority of Americans. Absolutely abhorrent. It worries me to death that, if my husband loses his job (which is auto industry related and tenuous in this economy), we will be without health insurance or will be paying unbelievable premiums to retain it. Health care should not be linked to a job. It’s a right (and a privilege), and one that should be available to every person in the country. And, by all accounts, the government here already runs a top line health system providing top class treatment —– the V.A. Check out John Stewart’s show with Bill Kristol.

When you say “top line”, Tammie, that would be the one recently receiving a great deal of media coverage for small details like their flagship hospital, Walter Reed, being infested with vermin and all sorts of other problems? Yes, Jon Stewart tricked Bill Kristol into saying something really dumb about the VA, but that’s hardly proof of anything relevant.

Walter Reed is NOT run by the Veterans Administration, but by the Department of Defense. The scandals you refer to have nothing to do with the VA, which provides excellent care and low administrative costs. If we weren’t hamstrung by ideology, ignorance, and the power of the insurance and drug industries, we could use it as a pattern for a national system.

I have just listened to the BBC’s Robert Peston chatting to Jim Chanos (not renowned for being a bleeding heart liberal). It is currently still available to hear online, via the BBC iPlayer – Radio 4, being the second episode in the series: ‘Peston and the Money Men’. According to Chanos, the future outlook for some of those profitting from the current (old) US health-care industry is pretty bleak. One interesting statistic (quoted in the final 3 minutes of the 29 minute program), concerned the cost of a single pacemaker. In the US the cost is $35000, while in Europe the same item is priced at $5000. Of course a 600% markup must be for R & D! I thought that this (apparent) fact might interest some other readers, if not you, James.

I’ve never had a problem getting an NHS dentist. My current one even opens late on a Wednesday evening to do a specialist surgery for us nervous patients. No idea how Roland Hulme managed to wait 15 years, unless it was for a dentist to personally attend his home…

The only thing with British dental care is that they won’t do purely cosmetic dentistry on the NHS – hence the wonky teeth stereotype. But that’s fair enough, really.

Yeah, I’ve had to hunt around for a dentist who will take NHS patients at times, but whenever I have they’ve been nothing but efficient.

Oh and whenever I have not been able to find one there’s always been the emergency walk in centre which is always willing to see you, I honestly cannot imagine the horror story about superglue can be formed by anything other than ignorance of the system. There IS emergency dental care for exactly that reason and I’ve never had to wait more than a few hours for it.

You must not have been doing it right. I mean 15 YEARS!? I registered with a NHS dentist in 1 day, and got an appointment two days after, and he is fantastic! Even as a child I had braces paid by the NHS, and have always been complimented on my great teeth! x

I am a Brit living in the US. I do have good dental care paid for by my husband’s employer. Let’s not get confused here, the dental care is separate from our medical coverage, as is the case with plenty of other people. My point is, that this excellent article was discussing general and specialised (not dental) care. I am pretty sure that there are even more people uninsured for dental in the US than there are for medical.

The thing is Amanda, America needs an NHS more than ever now. Globalisation has diminished wealth in the western world and America and companies are ever looking to streamline costs and reduce overheads in order to compete in a global market. Employers will axe heath coverage for their employee’s health insurance scheme as they won’t be able to afford them.

Roland, do you mean you waited 15 years for a dental appointment or 15 years to register with an NHS dentist?

Your inability to get NHS dental care validates the point I made – the NHS cannot be blamed when someone has no access to a dentist, because dentistry was part-privatised by the last conservative government. It no longer aims to cover the whole population.

For the record, I have not had an NHS dentist for SIXTEEN YEARS (almost to the day – I failed to qualify once I left home for university).

I have multiple chronic illnesses, and none of my local dentists feel qualified to treat me because they don’t know enough about how they affect my dental health. I bounced around the system for a while before I could get a referral to the local dental hospital. That ‘bouncing’ lasted 18 months. That’s the longest I’ve ever had to wait for dental care, and while it’s not great, it’s nothing like 15 years. I don’t personally know anyone who’s had to wait that long. Not at all.

Seriously? What county were you in, we all know that the care is not equal across the country but that I think Is crazy!

Did you make an appointment? were you actually registered, if you were and didn’t see your dentist within two years they take you off their books! I have’t seen and NHS dentist in years either, because there is a part-private plan which allowed me more choice and flexibility (due to the cuts in the NHS).

Cannot understand why 15 years! I am a UK resident in Leeds, Yorkshire, have two daughters, regular visits to the dentist! and beautiful teeth? AS do all my wider family members. You can have both NHS, private or a mixture if you choose.
Find a dentist and make an appointment.

Thank you, S, for sharing this. No system is perfect, but the misinformation flying around is driving me crazy. It’s always nice to hear from someone who has REAL knowledge and experience of a subject.

When I left Uni here in the UK I became really, really ill, and couldn’t work. I was on benefits for a while and it was horrible. I couldn’t explain what was going on – I was exhausted, in lots of pain all the time, having rel mental problems and my brain wasn’t working like it had at all. I couldn’t understand why I was stupider than I was.

Of course, my NHS doctor diagnosed me and sent me to an endocrinologist, who diagnosed me as having an underactive thyroid and various associated conditions and tested me for a range of other things just in case. I’m on medication for the rest of my life, but it’s free, and I never, ever have to worry about it. If I even feel a bit wonky I’ll be referred back to hospital, and ok, while there are delays, there are sneaky ways round, and I can pay to go private at any stage knowing I can go back to NHS at any stage.

It’s not perfect at all – but bear in mind I was ill as an adult, but before I started working full time (because I couldn’t) if I was in the USA, how could any of that happened? My medication is necessary to me to live – so it’s free. It completely blws my mind that if I was in the USA I’d have to pay – I honestly can’t conceive of a world where people have to *pay for insulin* – so what, a choice between food and living??

It also means that as long as I get my free card, I’ve got free healthcare all over Europe – so going on holiday or away for work I’m covered…..

“It also means that as long as I get my free card, I’ve got free healthcare all over Europe – so going on holiday or away for work I’m covered…..”

Nope – it means you get access to the same system as the natives of that country get, which in most cases is most definitely NOT free! In France, for example, you have a substantial co-payment unless you qualify for their means-tested exemption, and in Germany the system is largely private with premiums required, so I’m not sure your EHIC would get you anything at all. In Ireland, it means you can visit a doctor for a co-payment of about €40 – cheap, but again most definitely not free.

Moreover, the EHIC leaves substantial gaps in coverage, which is why you will be strongly advised to have private insurance. Air ambulance, medical evacuation/repatriation, flying your body home if you die – all excluded.

Finally, the EHIC’s only for holidays or short term visits: if you *move* to another EU country for that work you mentioned, you’re subject to their healthcare system, not the UK’s. Move to Germany, you will have to register with and start paying premiums to a ‘Kasse’, one of their health insurance companies: no more NHS, no more “free” anything.

It always baffles me how many Brits seem to assume that everywhere else has an NHS as well. They all have some form of healthcare system, but none uses the same approach as the NHS!

My husband was taken seriously ill in France a couple of years ago. The ONLY things we had to pay for were the valium he was intially prescribed (and that was much cheaper than a British prescription) and the taxi to the hospital when the valium didn’t work. We waved the EHIC at the medical staff at every opportunity, and his care in hospital was all covered.

However, you are right that it is adviable to have travel insurance; that covered my extra hotel bills, our missed holiday, and our repatriation.

If you are on holiday in Germany visiting me and have health problems you will be treated free, this is for each EU citicen the case anyways as well if you are from somewhere outside the EU i.e. the States. There are exemptions for people who visit only with a visa allowance, still one of part of such a visa allowance has to do with who covers the costs in case the visitor needs health care…. Been there with visiting friends who needed medical help incl. emergency room and intensive care for days in hospital. Got a letter with some questions to fill out from the council if I remember right and that was it…. on the other hand if I travel outside the EU I have an additional travel health insurance just in case I get ill during the travels and need medical help and do not want to be send away or bankrupt afterwards.

It is pretty strange to see a so called “christian” nation that is not willing to find a way to provide all their citizens with health care without getting paranoid about socialism, the banking crisis and bail out of banks, car producers etc…. that is called socialism to a much worse degree a national health care system would mean…. at least in a NHS system the tax payers have something from their taxes, the bank bail our only meant depth being socialised and profits still taken away by a handful of capitalists….

I don’t feel I can add much that hasn’t already been said either in your post or in others’ comments, I just wanted to say what a fantastically well-written post this was. I too have shared it with my family and friends. Thank you!

Thanks for sharing. I’m with you: I’d choose the NHS over the current crappy US system anytime.

As an American who was living in Britain for 10 years, I also have a fair idea of what’s good and bad about both systems.

I returned to the US earlier this year by choice. Not because I hated Britain but because I was ready for a change that also included four actual seasons. I’m self-employed, and in Massachusetts where I live, it’s one of the more progressive states. Health insurance is required, or you face a fine (or something like that) but getting health coverage isn’t negotiable for me so I’m fine with that.

Getting personal health coverage here has not been easy and has produced feelings of rage and helplessness in me. Want a doctor in your town? Check the website. Yep, make an appointment. What? Gosh, the website is … wrong…. she only practices in a town 10 miles away now. So I tried again. Nope. And I don’t own a car, either. Eventually I realised that I’d need to change to a different (more expensive) plan if I wanted a doctor in my town. At first I was told I’d have to wait for the 6 month mark to change my plan, but once I kindly explained in a very sad voice that their website is wrong and that I didn’t drive, they consented. Sheesh. But I had to pay a full month in advance. Now the billing is slightly haywire but I’m told it’ll get corrected on next month’s bill. Every penny counts when you’ve just moved, freelance and trying to get your business established. Oh and the best part? I found out from my practice’s receptionist that the hospital in our town doesn’t accept the coverage I had, hence why none of the doctors in town accept that coverage. WTH, couldn’t I have been told that when I enrolled? I mean, give me the all the facts, at least! Gee, thanks, current American health system!!!

The NHS is breathtakingly simple and painless in comparison. When you’re dealing with your health, the last thing you want is paper-pushers, admin hassles and misinformation.

One thing to note is that prescription meds are not ‘free’ in either system. In the UK, unless you meet certain criteria, you pay a flat rate of 7 GBP per prescription. I’ve only had one prescription here and it was $14.99.

Just so you know, 90% of prescriptions issued on the NHS come under the blanket of being free. It’s only 10% that have to pay that £7 charge, and it especially doesn’t apply to anyone who needs their medication to survive.

Lisa, I fully agree with you the NHS is the best system. As a business woman I’m sure you would want to be able to enjoy the money you make from your business and not have to lose it all if ever you became sick.
I annoys me how the right wing have tried to smear the NHS using the word socialised medicine to try and scare people with the S word. The fact is that in the States there is an NHS system for the military and the police, veterans and I believe other civil servants, and I believe other public sector workers.
I can’t understand why the word socialized is so scary because it has nothing to do with socialism.
Libraries, police, fire brigade, schools, military, water treatment are socialised, ans know one has a problem with them, so why not medicine it is the most important one of all.

Hi, i was brought here by an American friend living in the UK (through a Facebook link!). I came to read this, as the Repubilcans stance against the NHS has really hit a nerve with us Brits.

If i was born an America, I can quite honestly say, I would be probably not be alive today….

I was diagnosed with type 1 diabetes at age 14, during my high shool years. It came as a bit of a shock, but I collapsed at school during an exam, and the next thing I know Im in my local NHS hospital speaking with the Diabetes doctor (Dr Swift, legend that he is from Leicester Royal Infirmary). He spent 4 hours, thats right FOUR hours talking me through what had happened to me, and what I was now going to have to live with for the rest of my life. Insuline injections, Hypo’s, Hyper’s and the later in life problems with eye sight, feet and blood pressure. He then saw me once a day for the next eight weeks to essentially train me on what the symptons for a hypoglycemic attack were, how to test my blood sugar levels, how to inject the insulin etc. I also had my diabetic nurse pay me a home vist twice a week to check up on me until I told the clinic she no longer needed to do so! I was given a medical exemption certificate which makes me exempt from all prescription charges (Brits pay around £8 per prescription given to us by our docters, no matter what is on it) for the rest of my life, I visit the diabetic clinic at my loca hospital (15miles away, one has opened in my home town, but the nurses in Leicester have helped me through my darkest times!) every 6 months and have so many specialist tests done in an afternoon that it boggles the mind. I also have the number of my local diabetic nurse whom I can ring any time of day, and a sort of “hotline” to the clinic its self who I can call and speak to my doctor, feet specialist, eye specialist or even a dietician if I need it.

All of this care costs me, in my eyes, nothing. I pay my taxes (which are no higher than most other developed countries, and quite a lot cheaper than others at the band I am in) and just cannot comprehend people with a condition like mine, or worse, having to pay huge bills are simply accept they are going to die! How can the Republicans be spreading lies about something that does all of this for people like myself, whether they have insurance or not? It just boggles the mind. I would love to see some counter arguments and perhaps actual FACTS to give a little substance to the bile these are spreading but I fear we will never see it (except maybe about the Dental care, but as others have said, 75-80% of people are still seen by NHS dentists, I go private because that is free due to my diabetes!).

Stephen Hawkings summed it up the best, by simply saying “If it wasn’t for the NHS, I would not be here today”.

Don’t forget the problem of assymetric information, in the US it is in a doctors favour for the patient to recieve further care. In the UK they are not financially connected and the level of treatment has no effect on their financial circumstances.

Great post – just adding a comparison. Whilst on holiday in Florida I suffered with a tooth infection. I was in great pain – I was able to get to a doctor fairly easily but the shock was the cost. It cost me me over $300 for the consultation and some antibiotics. It’s only then that you realise what amazing value we get in the UK and we just take it for granted and don’t worry about it. And on prescriptions whilst they cost a fixed price in the UK – if you are unfortunate to have to take prescription drugs on a frequent regular basis there are options to make a one off payment to cover the year which is far less than all the repeated prescriptions.

[…] take the time to read a fellow re-pat’s post about her take on national healthcare over at Potential and Expectations. She lived there much longer than me and is much more eloquent than me. – BTW, she is an […]

Thanks for such a well written post, I am an American living in England now for 4 years and find that our stories are so similar. I too at first was skeptical and concerned, but then when I started using the NHS I marveled at how I had been so unconcerned at the American system! We (Americans) can really do better than where we are now with our healthcare but it is difficult to picture until you’ve experienced it.

I wouldn’t rate the NHS as 4 stars, but I too prefer it over the capital system (and I’m Republican). We have so many services in the USA that are socially and politically run, why not have one of the most important added to the list?

Schools
Fire Departments
Libraries
Hospitals

If children must be educated, fires must be put out and books made available to all why can’t we agree that health deserves the same status?

Corrine I could not agree with you more. The NHS is an important institution, and it does deserve the same status as the other establishments you have identified.
There have been some opponents who have said the NHS is socialism but I cannot see how it has any political label. After all the fire brigade, police, military, libraries water treatment etc are government run just like the NHS and they are not classes as socialist. They are classed as essential and neutral. Therefore why should we stick the S label to the NHS? We see a cop as a cop not as a republican or democrat, and so we should view the doctor in the same light.

This is an excellent post. As a British person, some of the things I’ve heard about the NHS are astonishing, and remind me of something you’d expect to hear about Nazi Germany. A balanced opinion is what is required, not scaremongering.

The protesters with healthcare seem to be protesting that everyone else shouldn’t have it? Madness in my mind.

Thank you. I’ve had a few American friends asking me recently if the Republican slanders are true. I was astonished to hear those ridiclous lies. Now I can link them your article. I’ve always had promt and excellent care from the NHS, as have my entire family, young and old.

Lisa Rex is right about prescription charges in the UK – but there’s a wide range of conditions where one is exempt from paying them. Basically, as far as I understand it, if you need it to live or function on a day-to-day basis, not only is that medication free, but all other medications you might need are also free, because of side-conditions and the fact that long-term conditions often leave people more susceptible to other things.

And yeah, it does come out of my taxes – but it’s only because of my healthcare that I’m actually well enough to have been able to pay taxes for the last 15 years. I’m in a good job, so adding it all together, I’m an investment. Without my thyroid medication I’d be reliant on benefits for the rest of my life, and costing a whole lot more to the state in the long term.

This is not quite true. As a kidney transplant patient, I was required to take immuno-suppressant therapy to prevent rejection of the organ, which would have either resulted in death or the need to re-commence more expensive dialysis. My medications were not free, although I could pay for a yearly ‘season-ticket, after which I didn’t pay anything.

Even if you are unfortunate enough to be in the 10% who need to pay for a yearly ‘season ticket’ – and if you were poor enough to be on welfare you wouldn’t be paying anything anyway – that ticket works out to £2 per month. Very, very cheap for healthcare.

Thanks for writing this – it is very useful to have the NHS put in context. I haven’t been following the debate on healthcare in the US closely but with a large proportion of the population not covered I always thought it was a no-brainer!

I really only experienced maternity and pediatric care in the UK, but I was very pleased. Like you said, I especially appreciated the midwife visits after bringing Kate home from the hospital. We had a lot of trouble establishing breastfeeding, and without the intensive help (and readmittance to the hospital!), I don’t know how it would have gone.

I enjoyed your article, but it’s only one side of the story. I have a very different opinion.

I’m an American living in the UK for about 3 years, and I prefer the AMERICAN system over the NHS. The NHS is truly a mixed bag, and lot of it depends on WHERE YOU LIVE. Instead of getting tied down to your employer for healthcare, in the UK you’re tied down to your address. It’s a bit like public education and good schools — if you want good healthcare you have to move to a place where the hospitals and doctors are good.

I live in West London. I have NO CHOICE of my GP. All the other GPs in my area are fully booked. If I don’t like my overworked doctor, the best I can do is choose on of the other two equally overworked doctors in that office. I have no other choices, unless I move.

My doctor makes all the decisions and I don’t have much choice about it — and usually neither does he. Here’s a textbook situation:

When I had a foot injury, I knew that I needed to go to a physiotherapist, and I could have worked through it quickly. The doctor agreed, but the NHS doesn’t allow him to make that referral. Instead he could only refer me to a podiatrist specialist. It took two weeks to get that appointment. The podiatrist also agreed that I probably needed to see a physiotherapist, but the NHS wouldn’t allow him to make that referral until I got an MRI scan. It was another two weeks before I could that appointment, and then another week to get a return visit to the podiatrist, and finally he was able to write a referral to a physiotherapist. Guess what? There aren’t many of them in my local area, and so of course they are extremely overbooked and I would have had to wait about another 3 weeks or more to get an appointment. Imagine limping around on a bad foot for about 2 months before getting the treatment that you really need. In the US, faced with a similar problem, my PPO insurance plan allowed me to go *directly* to a physiotherapist, as long as it was within their network, up to 10 times per year, for about a $25 co-pay. I would have gladly paid that to get the immediate care I needed!! And it wasn’t a gold-plated insurance plan, it was a very basic one compared to some of the ones I had when I worked in the US. American healthcare for the win!

What about employer insurance in the UK? Almost worthless, in my opinion. Since the NHS covers nearly everything, a company has no incentive to offer a comparable plan. It’s only good emergency cover, and only for very limited kinds of emergencies. For my wife’s pregnancy, the only things they cover are the most extreme emergency problems that would probably result in a miscarriage anyway. Furthermore, private insurance often won’t kick in until AFTER you’ve gone through the NHS! For my foot injury, my company’s insurance company *did* cover the cost for a physiotherapist, but only *after* the podiatrist specialist would approve it. Because I was able to use it I went to see a private physiotherapist only having to wait 1 week (for the insurance papers to go through), but I still had to wait over a month.

The NHS does *not* believe in preventative care. As he said, you only go when you’re sick — usually from something that was completely avoidable!! There’s no such thing as an annual checkup here. In America, I would go every year on my birthday for a checkup, blood & urine workup, and as I get older, prostate and other such exams. And it was always covered by all of the insurance plans I had, because they have an incentive for keeping you healthy, and nipping bigger problems in the bud. In the UK, I had to beg & plead my NHS-appointed GP to even give me a simple blood & urine panel to check for cholesterol, etc. So sure, if you get prostate cancer the NHS will take great care of you. But if you want to avoid getting prostate cancer in the first place, American healthcare wins again.

A few other issues I’ve had with the NHS:
– my pregnant wife practically missed her first trimester pre-natal scans and screenings because (as usual) the local maternity wards were full. First the GP would *not* refer us to the hospital of our choice because it was a little farther away. The problem is, all of the local hospitals were rated in independent studies as being near the bottom of the list for worst maternity wards in all of the UK (not just in London, but the entire UK). Then our case went into a black hole and unless we called and pushed the GP, she probably would have had the baby before we got re-assigned. We ended up having to pay for our scans from a private company. (Again, the company’s insurance plan doesn’t cover it because it’s not an emergency.’)

However, after all our pushing, we finally got reassigned to one of the better maternity wards in London, and now things are going very well. It’s further away and takes longer for us to get there, but the facilities and the care are so much better. It all has to do with location.

There are some good things about the NHS. Pregnant women get free medicine – the NHS co-pay is waved. My wife also has a chronic illness which requires regular scans and medications. She had to wait a bit to get referred to a specialist, but once that happened she is getting good care and the prescriptions are quite cheap because she only needs to pay the low NHS co-pay. I would also say that if I had a car accident, heart attack, or other emergency, the NHS would probably give me excellent care. (Then again, I felt the same way about the US, too.)

And dentists… don’t even bother. The NHS dentist offices in my area look like medieval torture chambers. I went once — flickering lighting, dirty, ancient equipment. They wanted to take an X-Ray and I told them to skip it — I’d probably get sterilized from the shifty-looking X-ray machine.

In my experience, as a pretty healthy mid-30’s male, is that I prefer the American health care system and I would not want it to turn into the NHS.

My biggest fear about the proposed changes is that the insurance companies will cut down their coverage and only offer limited, emergency care because they will have no incentive to compete in the basic-care market. I liked the preventative care that I got in the US and the ability to go directly to the specialists without having to be pre-screened by my GP. I liked having a choice of GP that’s not limited to where I live. Ditto for maternity care. I may have paid a bit more for the care, but I felt that I got my money’s worth.

“When I had a foot injury, I knew that I needed to go to a physiotherapist, and I could have worked through it quickly. The doctor agreed, but the NHS doesn’t allow him to make that referral.”

Umm, that’s not the case. I needed physio following a back injury, my GP referred me herself and I started treatment within 10 days.

Secondly, the NHS is very big on preventative care and GP surgeries routinely invite people to attend for various tests and check-ups. If your doctor isn’t doing that I suggest you have a word with your local health trust because they should be.

My experience was that, both times I’ve needed a physiotherapist (on the NHS), I’ve gone to my GP (in different areas of the country each time) and simply asked, and been referred within two weeks. Once I was not referred, because the GP had a set of recommended exercises for my problem, which I tried and which sorted it out. Had the exercises not worked, the next step would have been… to refer me to a physiotherapist.

Is it possible that your GP was ruling out a problem which physiotherapy would have made worse?

Interesting – I have never once been invited for any form of screening or preventative care by my GP except the routine vaccinations (MMR, Polio etc). When I wanted to get a meningitis vaccine before going to university, as was apparently recommended at the time, I had to order and buy the vaccine myself from another town, then deliver it to the GP surgery to get injected with it!

I know my mother has had some screening (breast, bowel and cervical cancer, I think, off-hand) – two of those don’t apply to me, of course, and presumably I’m too young to be screened for the other. I have literally never received any unsolicited contact from my GP: every single one of the handful of interactions I have had has been at my request.

My own experiences of the NHS have been quite negative, from very nearly dying during birth (complications in a hospital inequipped to deal with anything more than a papercut: the lone doctor in this micro-hospital was away at the time) to being offered a multi-year wait for a CT scan. The extra hoops to jump through for a referral sound very familiar as well. Kate, before dismissing his experience, bear in mind there are many separate ‘trusts’ within the UK, with different rules and procedures as well as different classes of GP with different referral budgets and constraints. It’s quite likely your particular GP has fewer referral constraints than LondonMitch’s.

My most recent GP visit, four years ago when I returned to this area and registered back with my old GP, entailed a total of five visits to register: two initial ones (to see the GP and then the nurse – on different days, because they aren’t scheduled sensibly), then the nurse referred me to the GP because she thought I had a cardiac arrythmia, so the GP referred me back to the nurse to get an ECG (a fourth visit: they only do ECGs on Tuesdays and Thursdays), and finally a fifth visit to get the results: there wasn’t an arrythmia after all. I haven’t seen or heard from my GP since.

On the bright side, I suppose, I “only” pay the government pay a few hundred pounds a month for this (half of that paid directly by my employer, the other half myself through payroll deductions) – 13% of my salary, as I recall.

“Kate, before dismissing his experience, bear in mind there are many separate ‘trusts’ within the UK, with different rules and procedures as well as different classes of GP with different referral budgets and constraints. It’s quite likely your particular GP has fewer referral constraints than LondonMitch’s.”

I can see your point, but if LondonMitch was told that, his GP was misleading him. They have been able to refer patients for physio for a very long time. It’s true not all GPs operate or are employed in the same way, but that is one basic thing they can all do. Anyone whose GP does tell them they need physio but it’s not possible to refer them, should make a complaint – and move to another practice.

You don’t get the call ins? We get reminders annually for well-women, well-men clinics, cervical screening etc. Anyone can go along and have various checks done. Maybe they think we look like an unhealthy lot lol

Being that the US healthcare system costs twice as much as the UK one, despite your experiences, deep in there you seem to be advocating the NHS. Imagine if the NHS had a 100% increase in funding- all the well known problems *could* be fixed.
I think what is clear through the debate is that its not *the UK system* which is a problem, its the details which are fixated on by the american right wing / lobbyists – this is not systematic of a “socialised” NHS, but underspending, misspent or poorly targeted funds. Easy to fix if you increase funding by 100%!!

It is interesting what you say about the annual check up; I suppose it works both ways, quite unalturistical for the US insurance company to minimise eventual cost of long term treatment. This is something which the UK govt CMO is now starting to talk about as the increase in cost of annual checkups should of course be offset by the reduction in long term care. Since the absurdities of the target chasing era are fading off, there is once again a focus on outcomes, and clearly prostate and breast cancer fatality rates which are high in the UK can be slashed by early detection through these methods.

I’m a UK native with no experience of US health care and I’m a big defender of the NHS but I believe every word that LondonMitch wrote.

I’m lucky enough to now live in an area with a fantastic local hospital; I have a possibly the best GP in the world (same day appointments even for non urgent cases 90% of the time); complete with smiley receptionist, friendly nurses; and a whole raft of services; the larger general hospital is good too and I’ve had first class service from them all over the last few years since being diagnosed asthmatic.

But I’ve been in a similar situation to LondonMitch before now, where YOU may know what you want and be entitled to it but the healthcare people around you don’t permit it. Luckily for me that’s 20 years behind me but there are still places in the UK where choice of GP is limited and the ones that do have space are usually the ones no-one else wants – normally for good reason, they’re bombastic, unfriendly and unhelpful. There are also some bloody awful hospitals out there too – yes they’re changing but they haven’t all changed yet.

In the last 6 or 7 years, there have been some huge strides in modernising and polishing up the NHS, it seems to have battled its way out of the mess it was in the 80s & 90s and found its way into the 21st century. But we’ll need people like LondonMitch to remind us that there are still pockets of awfulness so we can all put pressure on to remove those last miserable remains.

I couldn’t find a NHS dentist when I moved here in 1993 either (thank you Conservative party!). Luckily the private dentist I do use is great; I don’t think I’d move away even if an NHS one was available. A while ago I caught site of an NHS price list & was amazed that for the vast majority of treatment I was only paying a few ££s more than what I would pay on the NHS anyway, so I’m staying put.

But what happens to you if you loose your job and the health plan that goes with it?

No… I’m sure your fellow citizens would rally round and offer support when you need it….. I mean, it’s not like they’d let you die just because you aren’t insured, is it?

That’s irony, by the way (I hope you understood what I meant there? Or is ‘irony’ just another metal to you….?.)

I was diagnosed with MS about 8 years ago.

36 hours after falling ill, I had had a CAT scan, an MRI, x-rays, a lumber puncture and numerous other tests. After my first meeting with my neurologist, I found I didn’t get on very well with him, so I chose another. He is ranked as one of the best in Europe. (Mike Boggild – try googling the name with the term MS)

The only paperwork was…. what is your name, DOB, address and telephone number.

I’ve received and am still receiving state of the art drug treatment which costs approx £20,000 per anum! Delivered to my front door, every month.

I don’t pay for any of it. I COULDN’T afford to, even if I had to! Which I don’t….lol

If the drugs don’t work as advertised, the drug company REFUNDS the NHS 80% of the money spent on them treating me.

I receive a subsidised gym membership to help me keep active.

I have a free taxi service whenever I need it.

I have regular check ups and phone calls from the MS nursing staff. They also keep me appraised of all current research into MS.

I have active and ongoing support from my GP/ health team. (GP, 2 specialist nurses, a clinical psychologist and of course the neurologist)

I have the right to receive from the Government enough money to buy a new car (my choice) every three years. With free insurance, road tax and roadside assistance…

I have chosen not to take this, as it just feels wrong to me to take TOO much! :-)

The list goes on, but I think you get my drift?

My treatment and diagnosis must have cost a low 6 figures (so far)!

I’ve only paid for one thing! That was for a cup of coffee from a dispensing machine in the foyer of the hospital.

It was overpriced and horrible! I think I should sue them!!! :-(

SERIOUSLY

Could I get better treatment in America? Probably/Possibly.

IF I had the money.

Would it be less stressful?

ARE YOU KIDDING???

I want a doctor who sees me as a person in need of help, not a figure on a balance sheet.

When I first realised that you had to arrange for your own health care in the US, I didn’t believe it – thought the person who told me this was joking…..

I AM PUZZLED BY ONE THING, THOUGH

Why does anyone in this country care what the Americans think of the NHS? What difference does it make to us?

This is the country who voted for someone like Bush to govern them, remember? The Global Village Idiot, he was once described as…..

Now they have a President who is intellectually capable of doing the job……. and they still won’t let him help them.

This whole story has made me realise how better off we are with the NHS, than without it.

We should thank them for that…. but other than that, do we really care what they think?

The reason we have to care about what the Americans think (besides correcting misconceptions about our system to help them decide what they want) is that many politicians look to America when deciding what amazing new proposals to push through. Even when they pick a system that has worse average outcomes than the UK’s version (such as public schooling).

It is in our interest not to let ridiculous lies spread too far because certain parts of the media and certain politicians seem to steep themselves so heavily in American output that they can’t tell it from UK output, and don’t realise that most people in the country do not do this. If you want to avoid being fed the lies in 6 months time (despite them being easily disproved by 5 minutes research), it is well to correct them now.

Having said that, this fuss has made it really easy to identify at least one politician that I will never vote for short of ever other candidate proposing genocide. So that’s good.

If you lose your job you get Cobra it holds you over for a year, it doesn’t take that long to get jobs in America so you’ll almost certainly have another job with insurance in less than a year. That’s the benefit of low taxes, low taxes due to not having public everything allows businesses to keep more of their own money and thrive so jobs are plentiful. We may pay more for HC in America but everything else is cheaper because they don’t have to sneak in all sorts of VAT taxes to pay for universal everything. Just go down the list there’s not a commodity you guys don’t get robbed on. It’s all directly related! I’ve been there the cost of everything from milk to gas is ridiculous twice what we pay, that’s where you are paying for your healthcare and you don’t even realize it. sheeple! Don’t worry about the U.S. with a GDP per capita 1 1/2 times that of Britains and a an average wage 1 1/2 times Britain I think you should worry about yourselves…..Not to mention by far the strongest military on the planet! (all of it thanks to conservatives) The only unfortunate thing about being an American is you have to WORK you cant be LAZY. We didn’t become the strongest nation on the planet sitting on our DUFFS. My only fear is that the LOSER we have in the white house thinks like you and the country is starting to deteriorate. Yeah the loser you claim is so great added 7 trillion dollars to our debt in 5 years he’s on record to add more to our national debt then all other presidents combined. The only thing hes capable of doing is telling lies.

Not to mention America has the highest cancer survival rate in all categories of cancer, the UK is 16th

I’m not going as far into this comment as I would like, but think about where you are. London has the highest population density in all four countries of the UK. Did you expect people not to be overworked? Naive, I think.

If we had the kind of funding for the NHS that the American healthcare system has, it would probably be as good as US private treatment everywhere, but instead there are places like the one you experienced which happen to fall through the cracks. Remember, the NHS runs on half the income that US insurance companies get per year.

Also remember this: if you lost your job in England, you’d have a safety net for healthcare – and basic needs, if you were eligible to receive welfare here. Can you say the same about your beloved US system?

Great post Strawberry! I’m another repat who prefers the NHS to our American system. If you don’t mind I’ll be linking your post to several emails I’ll be sending regarding this very important subject.

Superb, very well balanced post. It is my belief that healthcare here in the UK ranks as some of the fairest and most efficient in the world. Every time I have to see a GP, I can get in within hours usually, sometimes the next day. Dentistry is extremely affordable. Hospital care is superb for the most part and is improving all the time. The UK has substantial problems that need to be sorted out, but it is my firm belief that the NHS is not one of them, and we should all be proud of Aneurin Bevan and his legacy.

I would fight to defend the NHS. I would march in the streets to keep it going and even as a non-affiliated voter, I admire to no end Clement Attlee and Nye Bevan for bringing into existence what can be considered as one of the greatest British achievements ever, and one that went on to revolutionise all of the developed world except the US.

London Mitch. If you dont like your GP or your surgery then change your office. I did. Sometimes you do have to wait until they are accepting new patients. This is exactly like my doctor in the states.

I have found that if you discuss your issues and tell the doctor what you would like done they will do it. I just asked my doctor to forward me to get a mole removed. Not a problems. Just like the HMOs in the states, you have to have a referal to see a specialist.

Dentists are tough on the NHS. It did take me two years to find one. I hold my hand up and say that I waited for a long time to start my search. That said, I could of had an appointment right away if I had gone private.

I have to wonder if you may be in the process of the steps of culture shock. The phase where nothing is good, everything sucks. I was there around year 3. Its a pretty normal place to be. Just make sure that its the actual system, not that you are in a place where you are not happy with anything, before you make a decision. Year 3 was a tough one and I liked nothing here. After nearly 6 yrs I am now content and can see things for what they are. Good and bad.

@butterflyspointofview HMO’s don’t really exist anymore in the US. They were deemed to be a failed experiment. Unfortunately the legislation being debated in the US right now goes right back to the failures of HMO’s by mandating gatekeepers that control the care we receive.

“HMOs don’t exist in the US” That’s as absured as some of the concervative scare tactics going on. Yes indeed, they DO exist . I’ve been an HMO member since 1984 and in that time I’ve had illnesses, accidents, surgeries, and broken bones, all of which have been covered fully with nary a denial in the bunch. I get excellent care from caring professionals.

As far as the “gatekeeper” comment, are you aware that in order to be accredited, an HMO MUST use clinical criteria based evidence-based data to make decisions? And that only an MD, PharmD, or DPsych can deny any request for a treatment or a service?

What’s wrong with healthcare in the US is the source of payment, not the delivery system. Everyone should have access to the kind of care I’ve had for the past 25 years.

Sorry, Tony, they definitely do. If they didn’t, my job before I moved here wouldn’t have existed–getting doctors onto HMOs’ panels! The go by all sorts of names–HMO, PPO, Hi-ded plan–but there are definitely gatekeepers, and probably more than you even know about.

Butterflyspointofview, I can hardly believe your dismissive reply to LondonMitch.

Culture Shock is not a term to be thrown around loosely, nor is it an experience that follows some sort of schedule. Just because you experienced a culture shock period lasting three years does not mean all or most expats will do the same. I was in the UK for 3 years and I barely experienced culture shock at all.

Suggesting that someone’s valid experiences with the NHS are a result of “culture shock” is, frankly, bullshit. I’m sorry, but it is. Mitch said something you don’t agree with or somehow can’t understand, so your answer is to tell him he’s basically imagining things? That’s nice!

I love England, its my second home, and I’m proud to be dual national. But I do not love England BECAUSE of it’s health care system. In fact, I love it in SPITE of it. I do not account for my distaste and distrust of the NHS because of culture shock, but simply because I had bad experiences. And believe me, I was not imagining things.

Mitch is entitled to his opinions and interpretations of own his experiences.

I guess the reason butterflyspointofview asks about culture shock is because some of the things LondonMitch describes are not true. You can walk into any GPs surgery or local drop-in centre and get seen and you can switch your GP whenever you like. You have the right to an annual check up too. He makes the dentist he visited sound like a medievel torture chamber, which I find incredibly unlikely. Also the NHS focuses much more on preventative care/medicine than does the US system.

Now, it may be the case that he doesn’t know about some of this, as this is not his home country, or because he has been misinformed somewhere down the line. He may even have been unlucky and had a couple of bad experiences, as can happen in any system, unless you are claiming that US healthcare is perfectly run? However bad expereinces are the rare exception, not the rule and he does seem to be viewing the whole system in a very bad light, based on a couple of subjective experiences. Hence the suggestion of culture shock. Butterflyspointofviews’ response was very reasoned and measured. It was your response to his post that was strident and defensive. I’d suggest objectivity next time, rather than just rushing in, headlong.

Thank you for a great, well-written, balanced post. As a US citizen with supposedly “great” healthcare coverage, I still have copays and limits and expensive prescriptions not covered by my insurance, crazy hassles with bills AND no vision or dental.

My fiance has no coverage, so we struggle to find the cheapest option for him, only to be socked by surprised $150+ testing bills that come weeks after we already paid for our visit and tests at the clinic.

And the wait! Are you kidding me? I’ve had to wait months to get an OB/GYN at the numerous different offices I’ve gone to. There’s nothing speedy about our private system.

I’m a Brit who has spent a few years living in the USA, so I’m seeing this issue from the opposite viewpoint.
I was sent to the USA by a multi-national company and I was fortunate to have comprehensive medical insurance.
What I found in the USA was that there were a lot more checks made on my health, which I don’t think would happen in the UK, and in three years there I spent more time in doctors’ surgeries and in hospital than in the previous 50. I didn’t think there was much difference in the standard of treatment between the two systems.
I have concluded that, if one has health insurance in the USA, then the checks and preventative procedures are more thorough than in the UK. I also concluded that sometimes these checks were unnecessary and were just done to generate fees for medical colleagues.
I don’t know what the situation is for anyone not having health insurance in the USA.

Greg–you’re not really that far off. If you have spectacularly good health care coverage in the US, you’ll USUALLY be well taken care of. (Not always, but that, like any other system, is because some people are better at their jobs than other people.)

The problem, and the debate, is because there are almost 50 million people who have no insurance at all, and no way of getting it. It’s less of an issue for the people who have it already, except that they seem to not want other people to get to have what they have.

I don’t honestly think the US health care system would go to hell in a handbasket if the government paid the bill instead of the people. Heard all kinds of horror stories, but the hospitals and doctors’ offices, unlike the insurance companies’ offices, are really full of people who are devoted, dedicated, and really want to make a difference in the world. I am convinced they’ll be the same good doctors no matter who’s footing the bill. ;)

See, that’s the thing: of course people receiving healthcare in the US are given more checks and preventative procedures. It generates more money for the insurance companies, as you say.

The NHS don’t do a great deal of preventative care before a problem has occurred at all (after is a different matter, but I won’t go into that in this comment), mostly because of their limited funding. Carrying out more procedures doesn’t generate more income for them, it simply uses up more of their assigned budget for any given year.

If we had the kind of budget as far as income goes that the US healthcare system runs on, which is twice what we do have, we probably would get more preventative care in the first instance.

Thankyou for putting together this post which covers everything I know to be true about my experience, but explains it a lot better!

I am British but married to an American, and have been living in Massachusetts for 5 years. Like all Brit, I complained about the NHS – kind of a national hobby, like complaining about theweatheror buses.

But to any English people reading this – be proud of your country, because you don’t realise what you have. Yes, the care is great over here, I have a great Doctor, but the treatment, waiting times, availability etc are no different in my experience, and in fact I feel I had more choice about which Doctor I could see back in England, as I didn’t have to consider which was covered by my insurance.

I have heard all of the negative things described in your post over here – many people truly do believe the things that have been said about how we have to see the one Doctor the government dictates, or whatever. People also do not understand that if you choose to, you still can have private insurance, and can take NHS care but pay for some things privately if you wish too. For example, I have had arthritis since the age of 10, and for a period of time my parents decided to pay privately for the blood work I had, and to see a specialist. I could have done this on the NHS but it was a matter of time because I was missing school with hospital visits, whereas it was easier to choose an appropriate time privately. But alongside this, I was still able to use NHS services for everything else, including prescriptions and daily physiotherapy, a therapist visiting my home, and visits to my GP.

I think there are many huge misconceptions about how life is in England over here, not just in this area. I hope, while I am enjoying the many wonderful aspects of American culture, I can help people understand a little more about my own, or at least make them consider there may be two sides to the debate!

Thanks again, I will will passing this on to others, and retweeting it!!

I’ve already suggested to my husband who is in New York working that he takes himself across the road to News Corp to offer his story of three major abdominal operations and the yearly check ups that he has had on the NHS.

My only gripe with the NHS is that they are/can be extremely selective about what infertility they will treat. In the end we had to go private or else we’d never have had our daughter, however I can’t imagine that had we been in the US it would have been easier or cheaper.

Re. the infertility thing, I have a strong suspicion (as a Brit) that that has to do with our increasing problems with overpopulation and the trouble with budgeting that the NHS has had in recent years. It’s just a thought, though. I couldn’t prove it.

I think it’s really important when talking about either system to keep in mind Strawberry’s point about the fact that an individual’s bad experiences in individual hospitals or doctor’s offices often cause them to form generalisations about the healthcare system as whole:

“… discovered that grumpy receptionists and dirty hospital bathrooms and annoying carparks can happen in any system — because they have nothing to do with the system itself. They’re management issues, human nature issues, and they happen everywhere. And a lot of the fear that Americans have about change in their healthcare actually center around these kind of issues that have nothing to do with the system itself, be it socialised or for-profit.”

My family have personally had some very bad first-hand experiences with the US healthcare system (my own sister is a healthcare worker in the US), but when I first moved to the UK, I still favoured the US system because it was what I knew. I do honestly believe the US hospitals and doctors offer some of the best care in the world, but the price for doing so is just too high. The freedom of not having to worry about my health insurance should I lose my job is incredibly freeing, especially during these tough economic times. I just spent three weeks in the US with family and friends and at least four different people in my close circle made references to having to delay expenditure or job changes because of the costs associate with healthcare. I am so glad I don’t have to worry about my healthcare coverage when making major life decisions anymore… and I wish the same for my family.

I grew up in America and now live in the UK. When I graduated college in the US, I got a job with a successful fortune 500 company. They provide a comprehensive health insurance plan and I could see any doctor I wanted, as long as they were on their list.

The list covered the entire state, but I had to ring 5 different doctors before I found one that would take me on as a patient.

The right wing are presenting American healthcare as some sort of infinitely available utopia where nobody’s treatment is rationed and everyone can choose to go anywhere they list is a big lie.

Yes the NHS is run by the government, and as you say, we can vote the government out of office if we don’t like the way they’re running the NHS.

Americans don’t get to vote against the boards of directors and shareholders of their insurance companies, so they are answerable to nobody as long as they’re making a buck.

“I have to wonder if you may be in the process of the steps of culture shock. The phase where nothing is good, everything sucks. I was there around year 3. Its a pretty normal place to be. Just make sure that its the actual system, not that you are in a place where you are not happy with anything, before you make a decision. Year 3 was a tough one and I liked nothing here. After nearly 6 yrs I am now content and can see things for what they are. Good and bad.”

I have some American acquaintances who live in UK and find absolutely everything wrong with it. They will just never be happy here. And I think because her doctor’s surgery (office) doesn’t have plush carpets, marble columns ….she thinks it’s all not as good.

In the UK I’ve been treated for hyperactive thyroid and also had my gallbladder removed all with top notch care. My hats off to the NHS and I just hope it keeps getting better and better.

Regarding UK dental care. Most of the problems with NHS dental care stem from the fact that the previous Conservative government (roughly equivalent to the Republicans) semi-privatised dentistry, much to the outrage of large sections of the population. This has made it harder to get an NHS dentist. This is NOT a problem with the NHS, quite the opposite. It is a problem with the privatisation of health care. We had a fine dentist, who upon retiring a few years ago sold his share of his joint dental practice to a young dentist recently out of medical school. He was good, provided excellent care, and was completely charming. And pretty soon he was telling us (via letter) that we had a couple of ‘choices’, neither of which involved simply staying the way we were as NHS patients. His ‘choices’ both involved private insurance programmes. We told him we were perfectly happy to stay as NHS patients. He wasn’t happy for us to stay as NHS patients. He forced us out.

Looking back the writing was almost literally on the wall. No sooner had the new dentist taken over the practice than a giant plasma screen appeared in the waiting room bombarding patients with propaganda for expensive and unnecessary cosmetic dentistry. I did an online search on our new dentist and found an old web page he had written while a student talking with great enthusiasm not about how he was looking forward to looking after his future patients, but how he was anticipating making LOTS OF MONEY!!! (and yes, he did write it in capitals with exclamation marks) once he was qualified.

This experience is really my only negative impression regarding the NHS and dentistry, and I must emphasis again, the negativity comes from privatisation and the pursuit of profit over healthcare. Otherwise I have had nothing but good experiences.

I am currently in the early stages of a course of treatment. Last week a capped tooth started to come a little loose. On Saturday night I started to get some discomfort and swelling in my mouth. This got progressively worse on Sunday, and on Monday I rang my dentist’s office and asked for an appointment. I received one for 8.25am the following day. I had an x-ray – the equipment was clean, modern and looked nothing remotely like anything from a torture chamber. I have an infection. My dentist prescribed antibiotics. Once the infection is under control work will begin on the tooth next Tuesday. I will require a total of four appointments, the making of a temporary cap, bridgework and eventually a permanent denture to be fitted in about 6 months when my gum has settled to shape. All this will cost me £198. If I was on social security it would cost me nothing.

My dentist himself is excellent. His assistant, likewise. She is constantly disinfecting and cleaning surfaces. The practice is meticulous about hygiene. I know everything which is being done, when, how and what it will cost. Now like other aspects of the NHS I believe it should be free at the point of delivery. Paying is the only grumble I have, but that is a political matter.

198 GBP for all that dental work? That is still cheap compared to what you would pay in the US (with insurance) for the same procedures! Just getting my wisdom teeth pulled (granted, it was all 4 at the same time) cost me over $900 – with insurance.

It cost you over $900 with insurance – that is insane! I use a private dentist in the UK and last year I had my wisdom teeth pulled out, a filing and some cosmetic work done. It took three appointments in total and the final bill came to about £300, which I paid as I don’t have insurance. I assume it would have been a lot cheaper on the NHS, but I have been going to the same dentist for years so I stayed with him after he switched from NHS to private work only.

I’ve lived in the UK for 8 months and have nothing but good to say of the NHS. I’ve been once to the GP for an ear infection (got in the same day I called, was diagnosed in 10 minutes. Total cost: £7.50 for the prescription), once to A&E for a sprained ankle (<2 hours in the waiting room, total cost: £0) and they have been as good as nagging me to get a pap smear, which I haven't been able to do for nearly 10 years due to lack of insurance in the US. My husband has been receiving treatment for sleep apnea, and all the appointments and referrals as well as his C-PAP machine and his tonsillectomy have been free. We definitely would not be able to afford his treatments if we lived in the US, so he would just have to take his chances with this potentially life-threatening condition. I can't believe that people would rather pay exorbitant amounts to greedy insurance companies, plus copays and deductibles, instead of paying directly for a good system that treats everyone.

I teach English to French students, and the other day in class I had to explain the US health care system to them. The shocked and horrified looks on their faces were a real eye-opener. We are so used to the US system that we don't always realise how exploitative and unfair it is. The US is the only developed country that doesn't offer decent health care to all its citizens. We're not always different because we're rugged individualists, sometimes we're different because we're just wrong.

Wonderful post, I am one who has long been skeptical of the claims about the NHS being a bad thing and I understand why the demogouges in this country use it as a boogieman. It is the ignorance of the population, Americans have for so long been told that we have the best this and the best that; but when you look at what this healthcare system does to the least of our citizens, we should be ashame of ourselves. I have expensiive private insurance and am still restrained from doing much in the way of prevenative care because of the high copays that go with each visit. Co-workers who have used their insurance have been barred from continuing to pay their premiums because the insurance company want their coverage to be dropped thus allowing them not to have to no longer pay for their illness. My mother never was able to get affordable insurance because of her Hypertension. Thanks for allowing us to share in your knowledge of a superior system of health care.

When I read about the American reactions to the prospect of a system comparable to NHS, I was stunned.

I am training to become a doctor and my experiences of the NHS both as a medical student, and a patient are very much positive. Of course, any system has problems, but I feel that to offer quality care FREE at the point of service is a remarkable achievement for our country, and one that I am truly proud of.

I cannot imagine not being able to book as many appointments with my GP as I wanted or needed, not being able to choose the doctor who treats me, or not being allowed to remain in hospital because of the costs. The NHS is there for those who need it most. In Britain, no one will be denied medical care, no matter who they are.

Get It Delivered!

Cast of Characters

Me: Late-30s, American just returned to the US after living for 15 years in rural England
M: Husband, mid-40s, English
E1: Elder daughter, born mid-2005, allergic to eggs
E2: Younger daughter, born early-2007, allergic to eggs, peanuts, treenuts, dairy, soy, lentils, chickpeas, beans, peas, chicken, avocado, bananas, cats, and possibly coffee and lanolin.
With guest appearances from the cat: as Herself

The Plot

An American Stay-at-Home Mum tries to find her direction in life, as she returns to the US with her English husband, after 15 years in the UK, and discovers how foreign her home country now feels. She also learns to negotiate the new and frightening world of food allergies, after her younger daughter is diagnosed with multiple, severe allergies.

The theme of Potential and Expectations explores the potential she once had and has now lost, and the potential she has yet to fulfill; the expectations that have been placed upon her in her life and those she still tries to live up to; and the nature of the unmarred potential her two daughters now possess, and the expectations she will choose to place upon them as they go through life, and those she will not.